Screening for depression among Latino immigrants in a free primary care clinic setting

Background: Integrated health care, or the systematic combination of physical and mental health services, has been shown to be effective in reducing health costs, improving health and mental health outcomes, and achieving continuity of care for patients. This study tested the feasibility of incorporating a depression screening tool within the usual care context of a free community-based primary health clinic serving primarily Latino immigrants in a large southwestern city. Methods: Undergraduate nursing students completing an eight week rotation at the clinic were trained to administer the instrument to patients who were waiting to be seen by a clinic health care provider. The trained nursing students distributed the instrument and were available to answer questions that arose during the administration. The Patient Health Questionnaire (PHQ-9), a nine item self-administered depression screening tool, was distributed to patients (N=83) while they were waiting to be seen by a provider at the clinic. Both Spanish and English versions of the survey were available, though 92.8% of respondents elected to complete the Spanish version. In addition, patients completed a short survey that included demographic questions as well as information about their present reason for visiting the clinic. Results: Results of the study indicate that 25% (N=21) of the sample had mild, moderate, or severe depression. Of these, only one patient indicated that he/she had come to the clinic seeking mental health treatment. Conclusions: The results of this study indicate that depression may be overlooked in the primary care setting by both patients and providers. Implementing the use of a brief self administered screening tool such as the PHQ-9 for all patients may help to guide treatment for depressed patients by alerting providers to the potential effects of depression on patients' physical health and wellness (eg., noncompliance, weight gain, fatigue). Creating a system of integrated health care can serve to address previously unidentified mental health needs and potentially lead to better overall health and wellness.